An intrauterine device (IUD) is a small, T-shaped device placed in the uterus that provides long-term, reversible contraception. IUDs come in two main types: hormonal, which release the progestin levonorgestrel, and non-hormonal, which use copper to prevent pregnancy. Menopause is a biological event confirmed after 12 consecutive months without a menstrual period, typically occurring around age 51. This article addresses whether IUD use can change the timing of this natural transition.
The Direct Relationship Between IUDs and Menopause Timing
Neither hormonal nor copper IUDs can delay the onset of menopause. Menopause is determined by the depletion of ovarian follicles, the small sacs in the ovaries that contain eggs. This process, known as follicular atresia, is continuous and genetically programmed.
The synthetic progestin released by a hormonal IUD is delivered locally to the uterus to thin the lining. This localized hormone does not circulate in high enough concentrations to influence the overall aging process of the ovaries. Since the IUD’s function is centered in the uterus and the biological clock for menopause resides in the ovaries, IUD use does not affect the age when a person enters menopause.
Masking Perimenopausal Symptoms with Hormonal IUDs
The belief that an IUD delays menopause arises because hormonal IUDs alter the menstrual cycle during the perimenopausal transition. Perimenopause is the stage leading up to menopause, characterized by fluctuating hormone levels that often cause irregular or heavy bleeding.
The levonorgestrel released by the IUD suppresses the growth of the endometrium, often resulting in very light bleeding or the complete cessation of periods. This mechanism is particularly useful for managing the heavy bleeding common in perimenopause.
Because irregular periods are a noticeable indicator of perimenopause, the absence of bleeding due to the IUD can mask this sign. A person may still experience other symptoms of declining estrogen, such as hot flashes, but the irregular menstrual cycle is absent. This masking effect creates the perception that the transition has not yet started.
Copper IUDs and the Menopausal Transition
Copper IUDs are entirely non-hormonal, using copper to create an environment toxic to sperm. Consequently, they do not interfere with the body’s natural hormonal signaling during the menopausal transition.
A copper IUD will not mask perimenopausal symptoms, but it may complicate the transition for some individuals. Copper IUDs are known to increase menstrual blood loss and are often associated with heavier or longer periods, especially in the first few months after insertion. If a person already experiences heavy bleeding due to perimenopausal fluctuations, a copper IUD may worsen this symptom. For this reason, the hormonal IUD is usually the preferred device for managing bleeding issues leading up to menopause.
IUD Removal and Confirmation of Menopause
When a person approaches the typical age of menopause (around 50 to 52), the IUD’s lifespan and contraception needs must be considered. Hormonal IUDs (such as the 52mg levonorgestrel system) and copper IUDs inserted after age 40 can often remain in place for contraception until age 55.
If a person has a hormonal IUD and has no periods, confirming menopause can be challenging. In this scenario, a healthcare provider may order a blood test to check levels of follicle-stimulating hormone (FSH) and estradiol. A consistently high FSH level, checked on multiple occasions due to natural fluctuations, is a laboratory indicator consistent with post-menopause.
If the IUD is removed before age 55, back-up contraception should be used until the person has gone 12 consecutive months without a period to confirm menopause has officially taken place. The IUD may also be left in place until it expires, or until the person is 55, as there is no harm in the device remaining in the uterus after menopause has occurred.